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Home My WebLink AboutDSHW-2018-005144 - 0901a0688083d87fDiv of Waste Management and Radiation Control APR 1 8 2018 _o__LteJ OMB# 2050-0024; Expires 05/31/2020 United States Environmental Protection Agency RCRA SUBTITLE C SITE IDENTIFICATION FORM 1. Reason for Submittal (Select only one.) DSH-14-2019 -0051 EJ ' Obtaining or updating an EPA ID number for an on-going regulated activity that will continue for a period of time. (Includes HSM activity) 0 Submitting as a component of the Hazardous Waste Report for 2017 (Reporting Year) 0 Site was a TSD facility and/or generator of > 1,000 kg of hazardous waste, > 1 kg of acute hazardous waste, or > 100 kg of acute hazardous waste spill cleanup in one or more months of the reporting year (or State equivalent LQG regulations) 13 Notifying that regulated activity is no longer occurring at this Site EJ Obtaining or updating an EPA ID number for conducting Electronic Manifest Broker activities 111 Submitting a new or revised Part A Form 2. Site EPA ID Number U T P 0 0 0 0 0 1 5 6 3 3. Site Name ACTION TARGET 4. Site Location Address Street Address 3411 SOUTH MOUNTAIN VISTA PARKWAY City, Town, or Village PROVO County UTAH State UT Country USA Zip Code 84606 5. Site Mailing Address 0 Same as Location Address Street Address City, Town, or Village State Country Zip Code 6. Site Land Type ['Private OCounty District ['Federal ['Tribal [il Municipal ostate Otherl 7. North American Industry Classification System (NAICS) Code(s) for the Site (at least 5-digit codes) A. (Primary) C. B. D. EPA Form 8700-12, 8700-13 A/B, 8700-23 Page _ of _ 0 1 OMB# 2050-0024; Expires 05/31/2020 EPA ID Number State Zip Code Country First Name SPENCER MI Title FACILITIES MANAGER Street Address City, Town, or Village !Last Name CHRISTIAN Email schristian@actiontarget.com Phone 801-705-9150 Ext Fax 8. Site Contact Information D Same as Location Address 9. Legal Owner and Operator of the Site A. Name of Site's Legal Owner El Same as Location Address - Full Name ACTION COMMERCIAL PARK Date Became Owner (mm/dd/yyyy) 1/1/2008 Owner Type rivate County District Federal Tribal Municipal State DOther Street Address P.O. BOX 420 City, Town, or Village SPRINGVILLE State UT Country USA Zip Code 84663 Email Phone Ext Fax Comments B. Name of Site's Legal Operator Same as Location Address Full Name ACTION TARGET Date Became Operator (mm/dd/yyyy) 1/1/2008 Operator Type ZPrivate County District Federal D Tribal Municipal El State Other Street Address City, town, or Village State Country Zip Code Email Phone Ext Fax Comments EPA Form 8700-12, 8700-13 A/B, 8700-23 Page _ of _ EPA ID Number U T OMB# 2050-0024; Expires 05/31/2020 10. Type of Regulated Waste Activity (at your site) Mark "Yes" or "No" for all current activities (as of the date submitting the form); complete any additional boxes as instructed. A. Hazardous Waste Activities Dv oN 1. Generator of Hazardous Waste—If "Yes", mark only one of the following—a, b, c I: a. LQG -Generates, in any calendar month (includes quantities imported by importer site) 1,000 kg/mo (2,200 lb/mo) or more of non-acute hazardous waste; or - Generates, in any calendar month, or accumulates at any time, more than 1 kg/mo (2.2 lb/mo) of acute hazardous waste; or - Generates, in any calendar month or accumulates at any time, more than 100 kg/mo (220 lb/mo) of acute hazardous spill cleanup material. I: b. SQG 100 to 1,000 kg/mo (220-2,200 lb/mo) of non-acute hazardous waste and no more than 1 kg (2.2 lb) of acute hazardous waste and no more than 100 kg (220 lb) of any acute hazardous spill cleanup material. E. c. VSQG Less than or equal to 100 kg/mo (220 lb/mo) of non-acute hazardous waste. lf "Yes" above indicate other generator activities in 2 and 3, as applicable, 4/ Y I/ N 2. Short-Term Generator (generates from a short-term or one-time event and not from on-going processes). If "Yes", provide an explanation in the Comments section. Dy EN 3. Mixed Waste (hazardous and radioactive) Generator Dy 1,/ N 4. Treater, Storer or Disposer of Hazardous Waste—Note: A hazardous waste Part B permit is required for these activities. Di, LIN 5. Receives Hazardous Waste from Off-site a EN 6. Recycler of Hazardous Waste JJ a. Recycler who stores prior to recycling JJ b. Recycler who does not store prior to recycling 111 y EIN 7. Exempt Boiler and/or Industrial Furnace—lf "Yes", mark all that apply. 0 a. Small Quantity On-site Burner Exemption JJ b. Smelting, Melting, and Refining Furnace Exemption B. Waste Codes for Federally Regulated Hazardous Wastes. Please list the waste codes of the Federal hazardous wastes handled at your site. List them in the order they are presented in the regulations (e.g. D001, D003, F007, U112). Use an additional page if more spaces are needed. C. Waste Codes for State Regulated (non-Federal) Hazardous Wastes. Please list the waste codes of the State hazardous wastes handled at your site. List them in the order they are presented in the regulations. Use an additional page if more spaces are needed. EPA Form 8700-12, 8700-13 A/B, 8700-23 Page — of — EPA ID Number o 5 OMB# 2050-0024; Expires 05/31/2020 11. Additional Regulated Waste Activities (NOTE: Refer to your State regulations to determine if a separate permit is required.) A. Other Waste Activities .1? 1. Transporter of Hazardous Waste—If "Yes", mark all that apply. — a. Transporter b. Transfer Facility (at your site) 2. Underground Injection Control D N 3. United States Importer of Hazardous Waste FlY P1 N 4. Recognized Trader—If "Yes", mark all that apply. a. Importer El b. Exporter v N 5 Importer/Exporter of Spent Lead-Acid Batteries (SLAI3s) under 40 CFR 266 Subpart G—If "Yes", mark all that apply. CI a. Importer b. Exporter B. Universal Waste Activities Dv ,, N 1. Large Quantity Handler of Universal Waste (you accumulate 5,000 kg or more) - If "Yes" mark all that apply. Note: Refer to your State regulations to determine what is regulated. JJ a. Batteries b. Pesticides D c. Mercury containing equipment Ei d. Lamps e. Other (specify) f. Other (specify) fJ g. Other (specify) DY V N 2. Destination Facility for Universal Waste Note: A hazardous waste permit may be required for this activity. C. Used Oil Activities Dy 0 N 1. Used Oil Transporter—If "Yes", mark all that apply, a. Transporter fJ b. Transfer Facility (at your site) Dy 0 N 2. Used Oil Processor and/or Re-refiner—If "Yes", mark all that apply. 0 a. Processor JJ b. Re-refiner Dy ve N 3. Off-Specification Used Oil Burner ny 0 N 4. Used 011 Fuel Marketer—lf "Yes", mark all that apply. 0 a. Marketer Who Directs Shipment of Off-Specification Used Oil to Off-Specification Used Oil Burner fJ b. Marketer Who First Claims the Used Oil Meets the Specifications EPA Form 8700-12, 8700-13 A/B, 8700-23 Page _ of _ EPA ID Number 0 0 0 1 5 6 3 I OMB# 2050-0024; Expires 05/31/2020 12. Eligible Academic Entities with Laboratories—Notification for opting into or withdrawing from managing laboratory hazardous wastes pursuant to 40 CFR 262 Subpart K. Dv ON A. Opting into or currently operating under 40 CFR 262 Subpart K for the management of hazardous wastes in laboratories—if "Yes", mark all that apply. Note: See the item-by-item instructions for defini- tions of types of eligible academic entities. 0 1. College or University EI 2. Teaching Hospital that is owned by or has a formal written affiliation with a college or university LII 3. Non-profit Institute that is owned by or has a formal written affiliation with a college or univer- Y SIN B. Withdrawing from 40 CFR 262 Subpart K for the management of hazardous wastes in laboratories. 13. Episodic Generation Ov N Are you an SQG or VSQG generating hazardous waste from a planned or unplanned episodic event, lasting no more than 60 days, that moves you to a higher generator category. If "Yes", you must fill out the Ad- dendum for Episodic Generator. 14. LQG Consolidation of VSQG Hazardous Waste EJY N Are you an LQG notifying of consolidating VSQG Hazardous Waste Under the Control of the Same Person pursuant to 40 CFR 262.17(f)? lf "Yes", you must fill out the Addendum for LQG Consolidation of VSQGs hazardous waste. 15. Notification of LQG Site Closure for a Central Accumulation Area (CAA) (optional) OR Entire Facility (required) Y IS N LQG Site Closure of a Central Accumulation Area (CAA) or Entire Facility. A.EJ Central Accumulation Area (CAA) El, Entire Facility B. Expected closure date: mm/dd/yyyy C. Requesting new closure date: mm/dd/yyyy D. Date closed : mm/dd/yyyy El1. 0 In compliance with the closure performance standards 40 CFR 262.17(a)(8) 2. Not in compliance with the closure performance standards 40 CFR 262.17(a)(8) 16. Notification of Hazardous Secondary Material (HSM) Activity DI I/ N A. Are you notifying under 40 CFR 260.42 that you will begin managing, are managing, or will stop manag- ing hazardous secondary material under 40 CFR 260.30, 40 CFR 261.4(a)(23), (24), or (27)? If "Yes", you must fill out the Addendum to the Site Identification Form for Managing Hazardous Secondary Material. Ely ON B. Are you notifying under 40 CFR 260.43(a)(4)(iii) that the product of your recycling process has levels of hazardous constituents that are not comparable to or unable to be compared to a legitimate product or intermediate but that the recycling is still legitimate? If "Yes", you may provide explanation in Comments section. You must also document that your recycling Is still legitimate and maintain that documentation on site. 17. Electronic Manifest Broker DV N Are you notifying as a person, as defined in 40 CFR 260.10, electing to use the EPA electronic manifest sys- tem to obtain, complete, and transmit an electronic manifest under a contractual relationship with a haz- ardous waste generator? EPA Form 8700-12, 8700-13 A/B, 8700-23 Page _ of _ Signature of legal owner, operator or authorized representative Date (mm/dd/yyyy) Printed Name (First, Middle Initial Last) Email Title T FP 6 I OMB# 2050-0024; Expires 05/31/2020 EPA ID Number 0 0 1 18. Comments (include item number for each comment) One time event during 2017. No longer generating hazardous waste, 19. Certification I certify under penalty of law that this document and all attachments were prepared under my direction or su- pervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gath- ering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. Note: For the RCRA Hazardous Waste Part A permit Application, all owners and operators must sign (see 40 CFR 270.10(b) and 270.11). Signature of legal owner, operator or authorized representative " --1"c Date (mm/dd/yyyy) Printed..Name (First, Middle Initial Last) -S,pe (er cti r Email Title FeiLl 1)44r1 Mc". a r e v2 oc4;e„, (I rcsr!ri. Maw- EPA Form 8700-12, 8700-13 A/B, 8700-23 Page _ of